Head injury/TBI and pain relief

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41 Female, fell of a horse, which promptly fell on top of her.  Reliable witnesses state + loss of consciousness, approx. 60-90 seconds, no seizure activity.  Patient now alert, asking repetitive questions, can not recall event, and complains of pain in symphisis pubis, 5/10 scale, no crepitus or instability noted.  Also has contusion/edema to R eye orbit, no facial bone instability.  VS normal (110/76, 92, no resp distress, SpO2 100% with 12lpm Oxygen.)  Chest and Abdomen normal (no signs of hemopneumothorax, abdomen soft, non-tender, no distention,) normal extremities (a few scrapes.)   

Ground crew called for helo evac (Basic EMTs on scene, nearest ground transport unit is 30 minutes away, and then would have a 45 minute drive to closest trauma hospital... Helo is 7 minute flight away from scene, 18 minute flight to ER.)  Oxygen, IV, spinal packaging.  

Any reason you can think of NOT to give her analgesia?  Options available include Fentanyl and Morphine.

Thanks for any input.

Best, 

Jeff Brosius
Flight Paramedic, etc.
Air Evac Services
Phoenix
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